Back in February, I got the chance to talk to Marsha Linehan, the developer of Dialectical Behavioral Therapy (read her bio here in PDF form), which was originally aimed at treatment of borderline personality disorder (BPD). I asked her a few burning questions such as: it’s been written that there is a high comorbidity rate of BPD and substance use disorders. What are the implications of this in terms of treatment? DBT is extremely popular in clinical settings right now—has any part of this explosive growth given you pause? And finally, how do we as mindfulness-based clinicians grow the field?

Her responses were that she hasn’t tried to grow the field of mindfulness-based clinical interventions. DBT, she told me, was not straight mindfulness, but mindfulness skills. She stated,

“Mindfulness may be a trend right now, there’s no doubt about it. The main thing to hold us back at this moment is the absence of data and limited research. They’ll do research. It’s not hard to research. There just isn’t much right now, and until there is, I won’t try to grow [the clinical mindfulness] field. I colead several retreats a year with therapists….the only people I only teach mindfulness to are looking for personal mindfulness practices. I’m a mindfulness teacher and a zen teacher. With my clients, however, I teach mindfulness skills, not straight mindfulness. We don’t know why it’s effective. What we know is that the group of skills are effective and mediate against relapse [of various clinical disorders].”

As for the correlation between borderline personality disorder, she stated, “Well, many things are comorbid with borderline and with substance abuse. It’s not surprising to see these two conditions occurring frequently together.”

In the interview, de Bonvoisin talks about the difference between people who think they are “good at” change and those who say they hate it; offers tips on how to make sure you’re one of the former; and identifies the ways in which mindfulness can be used during life change.

Ariane de Bonvoisin

De Bonvoisin says:

“Change is always an opportunity to pause, go inside, listen to our ‘inner microphone’ and be in the present. Our lives get so busy, we live based on routines, we never really ‘think’ we don’t want to change. So when change does happen, either by courageous choice or from life circumstances, it is asking us to be honest with what is, and also what is not working for us and our lives.”

On Monday night, about 20 people gathered in the quiet zendo of the Zen Center of Portland and settled themselves unto zafus and zabutons. Darren Littlejohn sat quietly and patiently at the front of the practice space and looked out at the faces gathered around him, eyes turned in his direction. It could’ve been any one of the thousands of sitting groups across the United States, but this group was different. In addition to being a Buddhist, Littlejohn is a recovering addict–and so were almost all of the people in attendance.

A few days later, I was sitting across from him at Bipartisan Cafe, a coffeeshop in southeast Portland. “I don’t consider myself a substance abuse counselor–I don’t have the training–but I consider myself in that field,” he said, taking a bite of his sandwich. Littlejohn’s been running his 12-Step Buddhist sitting group there since March of 2009, and it’s reaching a surprising number of people who want to learn how to use Buddhism and meditation to prevent relapse. With personal experience both in Buddhism and in the 12-step model, as well as an eerie memory for faces, Littlejohn seems uniquely poised to reach addicts who are looking for something a little different. Littlejohn used the 12-Step Buddhist approach in traditional addiction treatment settings for several years before taking it to the Zen Center, but he feels that running the group independently in the community is a better fit for him. His book, The 12-Step Buddhist, was published last year to wide acclaim.

Littlejohn likes Buddhism as an intervention because it’s customizable, saying that practicing Buddhism is not superior for relapse prevention than 12-step meetings–rather, it’s simply another way to assist recovery from addiction. For him, they both go together. “I don’t want to be one of the guys who practices meditation instead of going to meetings,” Littlejohn says. “If you can be an example of someone who goes on through suffering, you can create a strong movement. This is why I labor at this. If I can get one person on their own path, there’s no stopping them.”

With Buddhism as a tool for recovery, he says, “I feel freer to deal with people and meet them where they are.” He believes that people in recovery are uniquely qualified to help others into recovery. “You can’t fabricate the experience of waking up in your own puke. [If you haven’t been an addict yourself,] you can’t look at an addict and say, ‘Me too.’ ” Littlejohn believes that this applies to more than just issues of abuse; it’s also necessary in order to reach historically maginalized communities. “The majority of people I reach with this work are white, middle-aged, and predominantely female–not unlike the 12-step communities which I’ve been in my whole life,” Littlejohn said. Buddhism must grow on a grassroots level to reach other audiences, he says. “People from those populations are uniquely qualified to go back to deliver services to their communities,” he said.

His observation hints at a widely-known yet little-acknowledged truth: there is a lack of ethnic and racial diversity in the American Buddhist movement. A report on the subject by Harvard University’s Pluralism Project quotes bell hooks as saying, “when people of color are reluctant to enter predominantly White Buddhist settings it is not out of fear of some overt racist exclusion, it is usually in response to more subtle manifestations of white supremacy” (“Racial Diversity and Buddhism in the U.S,” 2006).

How does Buddhism–or addiction medicine, for that matter–reach a more diverse population? Littlejohn says he falls back on the universality of both Buddhism and the 12-step model of addictions treatment, as well. “I’m trying to introduce some concepts which can be used with any population, anywhere, regardless of criteria,” he says. “It’s not that the principles are flawed. In principle, the 12-steps are applicable to everyone, but we have a bit of tunnel-vision; ethnocentricity; groupthink mentality. I’m trying to open up the field so more people have the opportunity.”

“My general mission is to wake people up to what recovery is if they’re not in recovery, to wake people up to what Buddhism is if they’re not a Buddhist, and to help us all realize that we can all practice the dharma.”

But as mindfulness meditation moves beyond the realm of academics and adepts (those who have developed an impressive degree of aptitude in the practice of Buddhist meditation) into popular culture there’s growing pressure to distill mindfulness down to programs that can be articulated in sound-bites — or what is called in Hollywood an “elevator pitch.” Programs that can be described in one or two lines, the amount of time it takes to ride between floors on an elevator. Sometimes I joke about what seems to be a race to create the “Velveeta Cheese” of mindfulness programs–where wide dissemination, sustainability and replication are paramount, even at the expense of the wisdom upon which the classical traditions (and the programs) are based. …Is it possible to translate mindfulness into something that can be of benefit to everybody regardless of religion, ethnicity, education, or age without dumbing it down and forfeiting authenticity?

I had the opportunity to interview Dan Dickinson, who works for Kaiser Permanente as Clinical Services Manager in the Department of Addiction Medicine. Dan has a personal mindfulness practice and uses it in his work with clients. He states,

“People with addictions have incredible needs around self-maintenance, self-soothing, [and could benefit from] detachment from thought, just being able to observe thinking. Addiction patients are so much on automatic pilot, based on their drug use. Any sort of difficult feelings that they’re experiencing or their stressors, their automatic pilot will say “go get some sustenance,” from alcohol or whatever drug that they use. So I thought boy, this has some real relevance. I started bringing individual [mindfulness] skills into my practice from then on.”

Elisha Goldstein’s blog has recently posted a great interview with John Briere, a clinician in Los Angeles who specializes in trauma and the use of mindfulness in addressing it. This is a fabulous post and could be of special interest to addictions professionals, given how many of the people we work with have experienced trauma.

Dr. Briere says:

Mindfulness is a learnable set of skills, involving ongoing, moment-by-moment focused awareness and openness to the here-and-now, without judgment and with acceptance. It is, in some sense, the polar opposite of avoidance. Mindfulness can be a useful component of trauma therapy in several ways: the therapist can be mindful, which will increase her compassion and empathic attunement toward the client; she can communicate non-judgment, and acceptance, which the client may then internalize; and the client can learn mindfulness during treatment.